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F N0.19 HAZARDOUS WASTE MANS, " <br /> Please print or type (Form designed for use on eine{t¢pitch}typewriter) 2 page 1 .. <br /> Manifest <br /> r.Generators US EPA ID No. Document No. <br /> NON-HAZARDOUS . <br /> ,ofl <br /> WASTE MANIFEST GO 9,32 _5US 251 <br /> 3.Generator's Name and Mailing Address <br /> +J 1tt.2: i'at Cr�z1�-3r�nsty . <br /> tern Gree r- <br /> 520U 5'iil a Str��t, Ca �rc�, C:I. '90040 <br /> a.Generators Phone t 32 3 r'264-5200 <br /> US_EPA ID Number A.State Transporters ID <br /> 5.Transporter i Company Name <br /> . (�+AT 1 80 017 �3UE1 - B.Transporter 1 Phone 909-3'39-5507 <br /> �3z `'int Tr3z3, Tac. . . <br /> 8. US EPA ID Number C.State Transporters ID <br /> 7.Transporter 2 Company Name <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number - E.State Facility's,ID - <br /> � tajy Fnvr.�naeata� <br /> 3200 E. Fr�rlt r3 Strut r F.Facility's Phone <br /> C.kL UUU ?UO 5UU '714-630-2307 <br /> 92�UEJ 13. 14. <br /> - -12. Containers Total Unit <br /> 11.WASTE DESCRIPTION WtNol. <br /> No. Type Quantity <br /> a. <br /> 4XSTv L1.14IDS <br /> E b. <br /> E - <br /> l <br /> T ` <br /> O I <br /> R d: <br /> H.Handling Codes.for Wastes-Listed Above -� <br /> Q ,G.Additional Descriptions for Materials l isied Above :. <br /> N cl, non—.1I_azardo° _i3 wat?r <br /> O PROFILE #U4-f1",1T_U1--U59 <br /> i <br /> N 15.Special Handling Instructions and Additional Information J�'b �; Stoc�etaa F3cilit�► <br /> Q: 1990 ?icco l i '-R3.. <br /> Z GLOVES & '0G1CLE3 Stockton, C'1. ' 95215 <br /> O <br /> Z Eau,- <br /> E . <br /> 16.'GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> In proper condition for transport.The materials,described on this manifest are not subject to federal hazardous waste regulations. - <br /> Date <br /> M Day Year <br /> PrintedlTyped Nfle---7 Sign �+�7 Q <br /> f T 17.Transporter 1 Acknowledgement of Receipt of Materials - Date <br /> A Prints ed Name <br /> Signatu Month Day Year <br /> E S /V� .� <br /> E p 18.Transporter 2 Ackn_cwlAgement-of Receipt of Materials - Date <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space - <br /> I F <br /> A <br /> 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> Date <br /> [77�,7yped Name Signature Month Day Year <br /> Rev.3195 <br /> F-1402002..-L.ABELI$JASTERO(BW)621-6M8 www.labelmaster.com �PRKTEoar+aFcraeaPAPER nrow�rn - j <br />